The impact of diabetes mellitus on major amputation among patients with chronic limb threatening ischemia undergoing elective endovascular therapy- a nationwide propensity score adjusted analysis

Lilja, Erika; Gottsäter, Anders; Miftaraj, Mervete; Ekelund, Jan; Eliasson, Björn; Svensson, Ann Marie; Zarrouk, Moncef; Nilsson, Peter M.; Acosta, Stefan

doi:10.1016/j.jdiacomp.2020.107675

Cited by 6 publications

(6 citation statements)

References 34 publications

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“…This result differs from our previous study on patients endovascularly revascularized for CLTI, in which patients with DM and CLTI had a higher risk of major amputation. 9 After bypass surgery for CLTI on the other hand, two previous studies reported no difference in major amputation rate among patients with DM compared to those without DM, despite more advanced occlusive atherosclerotic lesions in DM resulting in a need of a lower level of the distal bypass anastomoses. 26,27 To be able to achieve equal results in patients with and without DM after bypass, however, it appears necessary to use the saphena magna vein as a bypass conduit, either as reversed bypass 27 or with an in situ technique, 26 and that the bypass is performed by a limited number of experienced vascular surgeons.…”

Section: Discussionmentioning

confidence: 94%

“…30 The present study showed a higher cumulative incidence rate of stroke and AMI in the group with DM, whereas Swedish patients with CLTI and DM undergoing endovascular therapy had a higher cumulative incidence rate of AMI only. 9 It is well-known that DM patients have a twofold increased risk of atherothrombotic ischemic stroke compared to those without DM, 31 and it can be speculated that patients needing an open vascular procedure have a more advanced generalized atherosclerotic disease rendering them more susceptible for ischemic stroke. In line with the present study results, Wallaert et al found a higher risk of major adverse composite events (myocardial infarction, dysrhythmia, congestive heart failure, wound infection, major amputation, and renal insufficiency) among patients with DM following lower extremity bypass surgery.…”

Section: Discussionmentioning

confidence: 99%

“…8 In a recent nationwide propensity adjusted analysis, patients with DM undergoing endovascular therapy had lower amputation-free survival and a clearly higher risk of major amputation compared to those without DM. 9 Since the proportion of patients with DM and CLTI undergoing elective endovascular therapy is increasing compared to open vascular surgery, [10][11][12] it is of great importance to investigate whether or not the results after urgently planned open vascular surgery are also associated with similar inferior results in DM patients.…”

Section: Introductionmentioning

confidence: 99%

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Diabetes mellitus was not associated with lower amputation-free survival after open revascularization for chronic limb-threatening ischemia – A nationwide propensity score adjusted analysis

et al. 2021

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The risk of major amputation is higher after urgently planned endovascular therapy for chronic limb-threatening ischemia (CLTI) in patients with diabetes mellitus (DM). The aim of this nationwide cohort study was to compare outcomes between patients with and without DM following urgently planned open revascularization for CLTI from 2010 to 2014. Out of 1537 individuals registered in the Swedish Vascular Registry, 569 were registered in the National Diabetes Register. A propensity score adjusted Cox regression analysis was conducted to compare outcome between the groups with and without DM. Median follow-up was 4.3 years and 4.5 years for patients with and without DM, respectively. Patients with DM more often had foot ulcers ( p = 0.034) and had undergone more previous amputations ( p = 0.001) at baseline. No differences in mortality, cardiovascular death, major adverse cardiovascular events (MACE), or major amputation were observed between groups. The incidence rate of stroke was 70% higher (95% CI: 1.11–2.59; p = 0.0137) and the incidence rate of acute myocardial infarction (AMI) 39% higher (95% CI: 1.00–1.92; p = 0.0472) among patients with DM in comparison to those without. Open vascular surgery remains a first-line option for a substantial number of patients with CLTI, especially for limb salvage in patients with DM. The higher incidence rates of stroke and AMI among patients with DM following open vascular surgery for infrainguinal CLTI require specific consideration preoperatively with the aim of optimizing medical treatment to improve cardiovascular outcome postoperatively.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diabetes mellitus was not associated with lower amputation-free survival after open revascularization for chronic limb-threatening ischemia – A nationwide propensity score adjusted analysis

et al. 2021

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“…Diabetes was also an unfavorable predictor of loss of patency. Many studies have reported less success with endovascular treatment in diabetic patients[19,20,21].…”

Section: Discussionmentioning

confidence: 99%

One-year results of long femoropopliteal lesions stenting with fasciotomy lamina vastoadductoria

Чебан

Osipova

Ignatenko

et al. 2022

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ObjectiveFasciotomy can increase the mobility of the superficial femoral artery and reduce the incidence of stent breakage. This study aimed to compare the long-term patency of drug-eluting nitinol stents with and without fasciotomy in patients with prolonged SFA occlusions.MethodsA randomized clinical trial was conducted in 60 (1:1) patients with long femoropopliteal steno-occlusive lesions more than 200 mm. Patients in group 1 (Zilver) underwent recanalization of occlusion of the femoropopliteal artery with stenting. In group 2 (ZilverFas), recanalization of the femoropopliteal occlusion with stenting and fasciotomy of Gunter’s canal were performed. The follow up evaluation of patency at 6, 12 months.Results12-month primary patency in Zilver and ZilverFas groups was 51% and 80%, respectively (p = 0.02). The freedom from target revascularization (TLR) in Zilver and ZilverFas groups was 50% and 76%, respectively (p = 0.04). At one-years, primary-assisted and secondary patency for the ZilverFas and Zilver groups were 83% versus 62% (p = 0.07), 86% versus 65% (p = 0.05), respectively. In groups Zilver and ZilverFas, the number of stents fracture was 14 and 7, respectively (p = 0.05). The Cox multivariables regression indicated that the stent fracture, diabetes mellitus were the independent predictor of restenosis and reocclusion. Fasciotomy reduced the chance of reocclusion and restenosis by 2.94 times.ConclusionsOur study has shown that a decompressing the stented segment with fasciotomy significantly improves the patency of the femoropopliteal segment and significantly reduces the number and severity of stents fractures.

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“…Additionally, diabetes mellitus (DM) increases the risk of developing CLTI four-fold (Becker et al 2011). Among patients who had undergone endovascular therapy for CLTI, the presence of DM further increased the risk of major LEA and myocardial infarction (Lilja et al 2020), signifying that CLTI in diabetics is more challenging to treat. In Asia, the burden of PAD and DM is already projected to increase, and the majority of Asian patients with PAD may have concomitant DM (Kawarada et al 2018).…”

Section: Introductionmentioning

confidence: 99%

One year clinical outcomes of Rutherford 6 chronic limb threatening ischemia patients undergoing lower limb endovascular revascularisation from Singapore

et al. 2022

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Background Percutaneous transluminal angioplasty (PTA) is widely used as a first-line revascularisation option in patients with chronic limb threatening ischemia (CLTI). This study aimed to evaluate the short-term endovascular revascularisation treatment outcomes of a cohort of Rutherford 6 (R6) CLTI patients, from a multi-ethnic Asian population in Singapore. Patients with R6 CLTI who underwent endovascular revascularisation from June 2019 to February 2020 at Singapore General Hospital, a tertiary vascular centre in Singapore, were included and followed up for one year. Primary outcome measures included number and type of reinterventions required, 3-, 6- and 12-month mortality, 6- and 12-month amputation free survival (AFS), wound healing success and changes in Rutherford staging after 3, 6 and 12 months. Results Two hundred fifty-five procedures were performed on 86 patients, of whom 78 (90.7%) were diabetics, 54 (62.8%) had coronary artery disease (CAD) and 54 (62.8%) had chronic kidney disease (CKD). 42 patients (48.8%) required reintervention within 6 months. Multivariate analysis revealed that the presence of CAD was a significant independent predictor for reintervention. Mortality was 15.1%, 20.9% and 33.7% at 3, 6 and 12 months respectively. AFS was 64.0% and 49.4% at 6 and 12 months. Inability to ambulate, congestive heart failure (CHF), dysrhythmia and CKD were significant independent predictors of lower 12-month AFS. Conclusions PTA for R6 CLTI patients was associated with relatively high mortality and reintervention rates at one year. CAD was an independent predictor of reintervention. More research is required to help risk stratify which CLTI patients would benefit from an endovascular-first approach versus conservative treatment or an immediate major lower extremity amputation policy.

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The impact of diabetes mellitus on major amputation among patients with chronic limb threatening ischemia undergoing elective endovascular therapy- a nationwide propensity score adjusted analysis

Cited by 6 publications

References 34 publications

Diabetes mellitus was not associated with lower amputation-free survival after open revascularization for chronic limb-threatening ischemia – A nationwide propensity score adjusted analysis

Diabetes mellitus was not associated with lower amputation-free survival after open revascularization for chronic limb-threatening ischemia – A nationwide propensity score adjusted analysis

One-year results of long femoropopliteal lesions stenting with fasciotomy lamina vastoadductoria

One year clinical outcomes of Rutherford 6 chronic limb threatening ischemia patients undergoing lower limb endovascular revascularisation from Singapore

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